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5.
REDUCE RISK OF INJURYWHILE HELPING OTHERS INNEED Majority of back problems are preventable with goodposture and body mechanics. Good posture (Fig 6) and body mechanics (Fig 7) is thesafest, most efficient, and most comfortable way to move. Youwill have more energy and less chance of backache, stiffness orinjury. Distribute the weight of the load evenly throughout yourspine, lowering your risk of injury.Fig 6 Fig 7 Fig 8

6.
REDUCE RISK OF INJURYWHILE HELPING OTHERS INNEED Bad Posture (Fig 8) is when the spine isdeviated away from the natural curves. Good Posture (Fig 6) is when your ears,shoulders and hips are in a straight line.Keeping all 3 natural curves in their normalalignment; your weight is evenly distributedthroughout the vertebrae and discs. Yourback is least vulnerable to injury when youhave good posture.

12.
How to decrease risk ofinjury SITTING STANDINGWALKINGPoor Good: use Poor Good: rest foot on a low PoorGoodlumbar support stool to relax back

13.
LIFTING/MOVING ANOBJECT or A PERSON When load is heavy, plan ahead and get help. Don’tbe shy to ask for help. Hold loads close to your body & tighten yourabdominal muscles. Keep back straight (neutral spine), feet apart(shoulder width) & your knees bent, lift with yourlegs to reduce the stress on your back. Lift objects only chest-high. Avoid quick, jerkymovements. If you have difficult time tightening your abdominalmuscles then you should wear a back support whenlifting. However, DO NOT wears the support all daybecause it can weaken your core muscles thatsupport your back unless you have a condition thatyour doctor wants you to wear it all day.

15.
LIFTING/MOVING ANOBJECT or A PERSON -Avoid bending trunk forward and twisting at thesame time. Move your torso-from your shoulders toyour hips-as one solid unit by moving your feet. (Fig11)Fig 11 Fig 12Bad Good Bad Good -Avoid reaching out over an obstruction to lift, hold orlower an object as much as possible. If you have toreach across a bed, rest one knee on the bed tosupport your lower back. Then bend from hips butkeep back straight not hunched over. (Fig 12)

16.
LIFTING/MOVING ANOBJECT or A PERSON Push, instead of pulling as much as possible. (Fig 13)Fig 13 Fig 14Fair Better REACHING OVERHEAD (Fig 14)-Store heavy and frequently used items at waist height.-Reach only as high as is comfortable but don’t stretch; use astool if you need it.-Test the weight of the load before lifting by pushing up on onecorner.-Let your arms & legs do the work, not your back. Tightenstomach muscles as you lift.

18.
OTHER WAYS TOREDUCE INJURY TOYOUR BACK Partial Sit Ups: Breathe in 1st. Tuckyou chin & belly in. Raise head andshoulders off the bed one spinesegment at a time as you breathe outslowly for 10 counts then go down inreverse as you breathe in.

21.
OTHER WAYS TOREDUCE INJURY TOYOUR BACK Wall Slide:Stand against a wall with your back and buttockstouching the wall. Place both feet about 6 inchesfrom the wall. Tuck your belly in. Slowly lower yourbody by bending the knees & slide down the wall untilthe knees are flexed about 45 degrees. Pause 5seconds and then slowly slideback up to the starting position.Keep the hips level and be sureyou are using your knee musclesto perform the exercise.

22.
 Take care of yourself so you cantake care of othersGood posture & body mechanics alsoapply to the ones that you care for.☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺

24.
Promote Independence Do range of motion to keep joints from getting stiff.Encourage the person to range on their own as muchas possible to ↑ circulation & prevent blood clot. Do weight bearing activities (i.e. standing, walking) asmuch as possible to prevent loss of bone density andability to sense what is up right posture. Do resistive exercises to keep muscles strong and toprevent bone density loss but must consult withyour physician & physical therapy first.

25.
Promote Independence Always allow the person to do as much asthey are able so they will not become weaker.When they are weaker, it’ll become harder for you. Provide help only when the person is not capable ofdoing it. Use assistive devices (overhead trapeze, slidingboard, draw sheet, hand rail, mechanical lift, hospitalbed…) if available to make getting around easier forall. To make sit to stand easier by scooting buttocksforward first, keep feet behind knees. Use bothhands to push down on armrests or bed to assist withstanding if able. (Discourage the person to pull up onthe walker for standing as much as possible becausethe walker can fall back on/with them).

26.
Communication -Always let the person knows what you aregoing to do & how they can help you. -If the person has dementia, keep instructionssimple & meaningful. (i.e. Let’s go eat, let’sgo check the mail or let’s go to the bathroom.Don’t say let’s go for a walk or stand up).

27.
Safety Not to wear socks (unless it is non-slip) or flipflops for walking. Always remind the person to feel the chair orthe bed behind both legs and reach for it withtheir hands prior to sitting down. Always stayclose to prevent the person from falling. Always repeat safety instructions every day tohelp the person remember. (i.e. don’t get upby themselves, always call for help if theydon’t have good balance).

28.
Safety During transfers, use a gait (transfer) belt. If no beltavailable, use a dress belt with a secure buckle.Place belt around the waist line or pants line. Holdon to the belt and pants. Hold on to the pants if beltis not available; however, the pants should not beelastic. During walking, stand to the side & slightly behind theperson. Hold on to the belt on the back side of theperson. The other hand should be ready to grab theshoulder in case the person loses balance. If the person loses the balance & you are not able tohold on. Do not strain yourself. Lower the person tothe ground slowly & safely. Anything that has wheels should be locked or placeagainst a wall or sturdy furniture.

29.
 If the person has breathing problems, keephead elevated at about 45 degrees to allowmore room for oxygen exchange in the lungs.(A wedge pillow is often helpful). If the person has a G-tube, make sure head iselevated > 45 degrees. Not to allow the person to lie down right aftermeals, wait at least 30 minutes. Pause after sitting up or standing up toensure no blackout or dizziness fromorthostatic hypotension (dropping of bloodpressure) before moving on.

30.
Safety If the person’s blood pressure becomes high, help bydoing the following relaxation exercises:1. Take a deep breath, pinch shoulder blades together& count to 10 then exhale slowly.2. Take a deep breath then roll shoulders backwardslowly 3 times.3. Take a deep breath, bring shoulders to ears & makeit very tight then count to 10. Exhale slowly as youlower both shoulders as low as possible & relax.4. Take a deep breath.5. Close eyes and meditate for 3 minutes as youbreathe in and out slowly.

31.
Comfort Position the person in 3 natural curves asmuch as possible so the person can becomfortable and able to tolerate a positionlonger. Place a small pillow at low back region whensitting. Use a sit straight pressure relief wheelchaircushion that provides pressure relief onsitting bones & also to assist the person to situp straight without a hammock effect.

32.
Prevent Skin Lesion Turn and change position every 2 hours if the person isnot able to do it on their own to prevent pressure sores. Do not allow both heels rest against the bed. Place apillow under legs above the ankles to keep both heelsaway from touching the bed. If has a hospital bed, raise the foot of the bed slightly toprevent the person from sliding down on the bed in orderto reduce sheer force (friction) on the skin. If the person has tendency of getting swollen limbs,elevate the limb above the heart & encourage the personto move actively such as ankle pumps or finger pumps ifable (except when they have active deep veinthrombosis). Wear compression garment when out of bedto control the edema in order to prevent skin lesion.

33.
Moving Up on a Bed Adjust bed height right below your waist if able. If not able, putone knee on the bed. Work from side of bed, feet pointed in direction you’ll move theperson. Reach under patient’s shoulders and back and slide, don’t lift. Ask the person to help by pushing against mattress with feetand/or elbows. Keep your feet wide apart,knees bent, back straight. When the person is not able tohelp at all: Use a draw sheet & 2 persons lift. Lift in unison.

35.
Getting In/Out of BED If a person requires a lot of assistance andhas a hospital bed, raise head of the bed tomake getting out easier. Roll the person to their side then have themuse elbow & hands to push up to sit. Do above sequence on reverse when goingback to bed.

36.
Transfers Transfer toward the stronger side of the body asmuch as possible. Allow the person’s head on the side of the directionwhere they are heading so they can see where theyare going in order to help you out as much aspossible. Always lock the wheelchair first. If coming out from bed to a wheelchair, raise the bedhigher than the wheelchair if able to make transfer &standing up easier. If going back to bed from the wheelchair, lower thebed than the wheelchair to increase ease of gettinginto the bed if possible.

37.
Transfers Support the person’s weak knee to preventbuckling. Let the person know, on a count of 3 stand &pivot (i.e. 1, 2, 3 stand & pivot). May userocking motion to gain momentum to stand upif the person is extremely weak. Make sure you keep your back straight, bendyour knees, use legs to lift. If the person must hold on to you, have theyheld your waist or shoulder, NOT NECK!

38.
Sliding board transfers Place wheelchair parallel next to the bed. Raise the bed slightly higher than thewheelchair if you are getting out of bed. Lower the bed slightly lower than thewheelchair if you are going back to bed. Remove arm rest of the side of the bed. Have the person lean away from the directionthey are going to place the sliding boardunder that cheek.

39.
Sliding board transfers Make sure the sliding board bridge the gapsecurely. Have to person to push down with their handsto scoot across the board if they are able.Make sure their fingers are not underthe board. Have your foot point towards the directionyou’re going. Bend your knees. Keep backstraight & help slide over.

40.
Bath Tub Transfers UsingTransfer Bench To transfer from a wheelchair to a bath bench, placethe wheelchair so that it faces the front of the tub,next to the bench. Remove wheelchair armrest of theside of the bench. Transfer your torso from the wheelchair to the benchthen lift each leg into the tub. Slide over until you are sitting in front of the backrestin the center of the tub. Grab the arm rest to help youslide over, if needed. Move slowly and avoid twistingto prevent injuries. To transfer back to the wheelchair, slide over to theedge of the bench, lift each leg over the tub wall, andthen transfer your torso into the wheelchair.

41.
Bath Tub Transfers UsingTransfer Bench To transfer to a bath bench from a standing position,sit down on the side of the bench that is outside thetub. Reach out and grab the arm rest for support, ifneeded. Lift each leg over the side of the tub wall. Slide your body over to the center of the bench, withthe backrest behind you. To get out of the bathtub, slide overto the edge of the bench, lift eachleg over the tub wall, and push yourselfup from the bath bench. Move slowlyand avoid twisting to prevent injuries.

42.
Car Transfer Open the door as wide as possible. (may place a plastic bag ona seat under a towel to make sliding in and out easier. Place wheelchair next to the car & lock the wheels. (make sureto have enough room for 2). Stand pivot with then sit on the car seat then swivel legs into thecar. When coming out of the car; reverse the sequence. If able to walk with an walking aid: walk towards the car seat,turn to back up to the seat then hold on to the car to sit thenbring your legs in. Reverse the sequence when coming out ofthe car. Make sure not to place your hand at where it might getjammed.

43.
Positioning in aWheelchair Lock the wheelchair. Scooting a person back into awheelchair: have the person’s armscrossed then put your hands throughunder the armpits then hold onto theirwrists or grab their pants to scoot back. Place a small pillow at low back area tomaintain a natural curve.

44.
Positioning in aWheelchair Rest feet on foot pedals. Knees should be slightlyhigher than the hips to increase comfort for low backarea (It the person had recent total hip replacement,the knees will have to be lower than hips). It is best to lower wheelchair seat height so that theperson’s feet can be flat on the floor with knees at thehip height in order to promote mobility & keep lowback in natural curvature. (Should use foot pedalswhen moving the person in the wheelchair to preventleg injuries). Use leg rest to elevate both legs if has problem withedema in the legs.

46.
Falls If the person is having a lot of pain &not able to move then call 911. If the person does not have pain or painis mild, then bring a chair that theperson can grab to get up from thefloor.

47.
How to adjust walkingdevices -Elbow should be bending at about 25 to 30 degreeangle to be more advantageous. -Or have the person stand with arms resting at his orher sides and adjust it so that the handles are at the height of the person’s wrist. -If the person’s posture falls backward then thewalking device is too tall; it the person bend forwardthen the walking device is too low. -Make sure you are wearing the walking shoes whenmaking the measurement.

49.
How to use a rollator or a fourwheeled walker with a seat safely Not to use it like a wheelchair & not to walk with thewalker far from you. Squeeze the brakes like the bicycle brakes whenwalking down hills/inclines to slow down the walker.Always keep the wheels locked before sitting in it orstanding up from it. Best to have the walker against a wall or sturdyobject to prevent the walker from moving since thebrakes have tendency to fail. Hold on to both handles & pull ittowards your buttocks prior to sitting in it.